Medical Conditions

Neonatal Abstinence Syndrome (NAS)

Content reviewed against published AAP, NIH, March of Dimes guidelines

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If your baby has been diagnosed with or you suspect neonatal abstinence syndrome (nas), here is what the evidence says.

The short answer

Neonatal abstinence syndrome (NAS) occurs when a baby is exposed to certain substances, most commonly opioids, during pregnancy and experiences withdrawal symptoms after birth. Symptoms can include excessive crying, tremors, poor feeding, and sleep problems. NAS is a treatable condition, and with proper medical care, most babies recover well. Non-judgmental support and medical monitoring are essential.

Key takeaways

  • Neonatal abstinence syndrome (NAS) occurs when a baby is exposed to certain substances, most commonly opioids, during pregnancy and experiences withdrawal symptoms after birth. Symptoms can include excessive crying, tremors, poor feeding, and sleep problems. NAS is a treatable condition, and with proper medical care, most babies recover well. Non-judgmental support and medical monitoring are essential.
  • Usually normal when: Your baby had mild NAS symptoms that were managed with non-pharmacological care and has been cleared for discharge
  • Call your doctor if: Your baby has seizures, severe vomiting or diarrhea leading to dehydration, or is refusing all feeds, as these are signs of severe withdrawal that require emergency medical care
  • Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

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By Age

What to expect by age

0-48 hours

NAS symptoms can begin as early as a few hours after birth, though the timing depends on the substance involved. Opioid withdrawal symptoms typically appear within 48-72 hours of birth, while some substances can cause delayed onset. The hospital team will assess the baby using a standardized scoring tool (such as the Finnegan Neonatal Abstinence Scoring System or the Eat, Sleep, Console method) to evaluate the severity of withdrawal. Rooming-in with the mother and skin-to-skin contact are first-line treatments and can significantly reduce symptom severity.

2-7 days

This is typically when NAS symptoms peak. Symptoms may include high-pitched or excessive crying, tremors or jitteriness, difficulty feeding, frequent yawning or sneezing, tight muscle tone, poor sleep, sweating, and in some cases loose stools or vomiting. The Eat, Sleep, Console approach focuses on keeping the baby comfortable through non-pharmacological methods such as swaddling, quiet environments, frequent small feedings, and parental presence. If symptoms are severe despite these measures, medication (typically morphine or methadone) may be used to ease withdrawal gradually.

1-4 weeks

Babies with mild NAS may have symptom resolution within 1-2 weeks. Those requiring pharmacological treatment typically have a hospital stay of 2-4 weeks or longer as medication is slowly weaned. Breastfeeding is encouraged in most cases (if the mother is in a stable treatment program and not using illicit substances) because it provides comfort and small amounts of the substance that can ease withdrawal. Before discharge, the medical team ensures the baby is feeding well, gaining weight, and symptoms are controlled.

1-3 months

After discharge, babies who had NAS may continue to be more irritable, have difficulty with sleep regulation, and be harder to soothe than other newborns. These issues typically improve gradually over the first few months. Regular pediatric follow-up is important to monitor growth, development, and feeding. Developmental screening is recommended because prenatal substance exposure can occasionally affect long-term development, though many children with a history of NAS develop normally with appropriate support.

What Should You Do?

When to take action

Probably normal when...
  • Your baby had mild NAS symptoms that were managed with non-pharmacological care and has been cleared for discharge
  • Your baby completed a medication wean in the hospital and is now feeding and sleeping well
  • Some mild irritability or difficulty with sleep regulation in the first few months after NAS, which is gradually improving
  • Your baby is meeting developmental milestones and gaining weight appropriately
Mention at your next visit when...
  • Your baby continues to be excessively irritable, has difficulty with feeding, or has poor weight gain after discharge
  • You are concerned about your baby's development or ability to self-soothe
  • You need support or resources for your own recovery while caring for your newborn
Act now when...
  • Your baby has seizures, severe vomiting or diarrhea leading to dehydration, or is refusing all feeds, as these are signs of severe withdrawal that require emergency medical care
  • Your baby is excessively limp, not waking to feed, or has difficulty breathing, as these could indicate a serious medical issue beyond typical NAS symptoms

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Neonatal Abstinence Syndrome (NAS).

Things to mention

  • Your baby continues to be excessively irritable, has difficulty with feeding, or has poor weight gain after discharge
  • You are concerned about your baby's development or ability to self-soothe
  • You need support or resources for your own recovery while caring for your newborn

Observations to share

  • Your baby continues to be excessively irritable, has difficulty with feeding, or has poor weight gain after discharge
  • You are concerned about your baby's development or ability to self-soothe
  • You need support or resources for your own recovery while caring for your newborn

Urgent signs to report immediately

  • Your baby has seizures, severe vomiting or diarrhea leading to dehydration, or is refusing all feeds, as these are signs of severe withdrawal that require emergency medical care
  • Your baby is excessively limp, not waking to feed, or has difficulty breathing, as these could indicate a serious medical issue beyond typical NAS symptoms

My notes

From ismybabyalright.com — free, evidence-based baby health guides

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is neonatal abstinence syndrome (nas) normal?
Neonatal abstinence syndrome (NAS) occurs when a baby is exposed to certain substances, most commonly opioids, during pregnancy and experiences withdrawal symptoms after birth. Symptoms can include excessive crying, tremors, poor feeding, and sleep problems. NAS is a treatable condition, and with proper medical care, most babies recover well. Non-judgmental support and medical monitoring are essential.
When should I call the doctor about neonatal abstinence syndrome (nas)?
Your baby has seizures, severe vomiting or diarrhea leading to dehydration, or is refusing all feeds, as these are signs of severe withdrawal that require emergency medical care Your baby is excessively limp, not waking to feed, or has difficulty breathing, as these could indicate a serious medical issue beyond typical NAS symptoms
When is neonatal abstinence syndrome (nas) normal?
Your baby had mild NAS symptoms that were managed with non-pharmacological care and has been cleared for discharge Your baby completed a medication wean in the hospital and is now feeding and sleeping well Some mild irritability or difficulty with sleep regulation in the first few months after NAS, which is gradually improving
What causes neonatal abstinence syndrome (nas)?
Neonatal abstinence syndrome (NAS) occurs when a baby is exposed to certain substances, most commonly opioids, during pregnancy and experiences withdrawal symptoms after birth. Symptoms can include excessive crying, tremors, poor feeding, and sleep problems. NAS is a treatable condition, and with proper medical care, most babies recover well. Non-judgmental support and medical monitoring are essential. Common explanations include: Your baby had mild NAS symptoms that were managed with non-pharmacological care and has been cleared for discharge. Your baby completed a medication wean in the hospital and is now feeding and sleeping well.
What should I mention to my pediatrician about neonatal abstinence syndrome (nas)?
You should mention neonatal abstinence syndrome (nas) at your next visit if: Your baby continues to be excessively irritable, has difficulty with feeding, or has poor weight gain after discharge. You are concerned about your baby's development or ability to self-soothe. You need support or resources for your own recovery while caring for your newborn.
Is neonatal abstinence syndrome (nas) normal at 0-48 hours?
NAS symptoms can begin as early as a few hours after birth, though the timing depends on the substance involved. Opioid withdrawal symptoms typically appear within 48-72 hours of birth, while some substances can cause delayed onset. The hospital team will assess the baby using a standardized scoring tool (such as the Finnegan Neonatal Abstinence Scoring System or the Eat, Sleep, Console method) to evaluate the severity of withdrawal. Rooming-in with the mother and skin-to-skin contact are first-line treatments and can significantly reduce symptom severity.
Is neonatal abstinence syndrome (nas) normal at 2-7 days?
This is typically when NAS symptoms peak. Symptoms may include high-pitched or excessive crying, tremors or jitteriness, difficulty feeding, frequent yawning or sneezing, tight muscle tone, poor sleep, sweating, and in some cases loose stools or vomiting. The Eat, Sleep, Console approach focuses on keeping the baby comfortable through non-pharmacological methods such as swaddling, quiet environments, frequent small feedings, and parental presence. If symptoms are severe despite these measures, medication (typically morphine or methadone) may be used to ease withdrawal gradually.
Should I go to the ER for neonatal abstinence syndrome (nas)?
Seek emergency care if your baby has seizures, severe vomiting or diarrhea leading to dehydration, or is refusing all feeds, as these are signs of severe withdrawal that require emergency medical care, or if your baby is excessively limp, not waking to feed, or has difficulty breathing, as these could indicate a serious medical issue beyond typical NAS symptoms. When in doubt, call your pediatrician's after-hours line for guidance.
Does neonatal abstinence syndrome (nas) go away on its own?
In many cases, neonatal abstinence syndrome (nas) resolves on its own, especially when your baby had mild NAS symptoms that were managed with non-pharmacological care and has been cleared for discharge. By 1-3 months, after discharge, babies who had NAS may continue to be more irritable, have difficulty with sleep regulation, and be harder to soothe than other newborns. These issues typically improve gradually over the first few months. Regular pediatric follow-up is important to monitor growth, development, and feeding. Developmental screening is recommended because prenatal substance exposure can occasionally affect long-term development, though many children with a history of NAS develop normally with appropriate support.
AAPNIHMARCH OF DIMES

References

  1. [1]American Academy of Pediatrics. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020;146(5):e2020029074. AAP
  2. [2]National Institute on Drug Abuse. Neonatal Abstinence Syndrome (NAS). NIH
  3. [3]March of Dimes. Neonatal Abstinence Syndrome (NAS). March of Dimes

All content follows our editorial policy and is reviewed against published clinical guidelines.

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Bottom line

Most cases of neonatal abstinence syndrome (nas) are normal. Talk to your pediatrician if your baby has seizures, severe vomiting or diarrhea leading to dehydration, or is refusing all feeds, as these are signs of severe withdrawal that require emergency medical care.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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